BENZODIAZEPINES IN SCHIZOPHRENIA

Benzodiazepines have a checkered history in the United States; public and professional attitudes about them have ranged from their being won der drugs in the 1970s to being virtually purged from many formularies as addictive and dangerous in the 1980s. The attitude today is that t hey are useful for specific indications. In the last 20 years they hav e been investigated as adjunctive agents to conventional antipsychotic drugs in the treatment of schizophrenia. Benzodiazepines may be effec tive in schizophrenia because stress is one mediator of relapse in the se patients. In addition, inhibition of dopamine neurotransmission thr ough gamma-aminobutyric acid-enhancing activity may provide a direct a ntipsychotic effect. As monotherapy or adjuncts to antipsychotic agent s, benzodiazepines produced antipsychotic effects in schizophrenia in approximately 50% of controlled trials. Although there is no particula r benzodiazepine of choice, low-potency compounds with long eliminatio n half-lives are recommended. Adverse effects of concern include sedat ion and cognitive impairment, behavioral disinhibition, exacerbation o f psychotic symptoms, and the potential for dependence, withdrawal, an d abuse. The recent arrival of atypical antipsychotic drugs has signif icantly slowed research and interest in benzodiazepines in schizophren ia beyond their initial beneficial sedative effects for acute psychoti c episodes.